Who is tested for diabetic kidney disease and who initiates treatment? The Translating Research Into Action for Diabetes (TRIAD) study

Susan L. Johnson, Edward F. Tierney, Kingsley U. Onyemere, Chien Wen Tseng, Monica M. Safford, Andrew J. Karter, Assiamira Ferrara, O. Kenrick Duru, Arleen F. Brown, K. M.Venkat Narayan, Theodore J. Thompson, William H. Herman

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE - We examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients. RESEARCH DESIGN AND METHODS - We conducted surveys and medical record reviews for 5,378 patients participating in a study of diabetes care in managed care at baseline (2000-2001) and follow-up (2002-2003). Factors associated with testing for albuminuria were examined in cross-sectional analysis at baseline. Factors associated with initiating ACE inhibitor/ARB therapy were determined prospectively. RESULTS - At baseline, 52% of patients not receiving ACE inhibitor/ARB therapy and without known diabetic kidney disease (DKD) were screened for albuminuria. Patients ≥65 years of age, those with higher HbA1c, those with cardiovascular disease (CVD), and those without hyperlipidemia were less likely to be screened. Of the patients with positive screening tests, 47% began ACE inhibitor/ARB therapy. Initiation of therapy was associated with positive screening test results, BMI ≥25 kg/m2, treatment with insulin or oral antidiabetic agents, peripheral neuropathy, systolic blood pressure ≥140 mmHg, and CVD. Of the patients receiving ACE inhibitor/ARB therapy or with known DKD, 63% were tested for albuminuria. CONCLUSIONS - Screening for albuminuria was inadequate, especially in older patients or those with competing medical concerns. The value of screening could be increased if more patients with positive screening tests initiated ACE inhibitor/ARB therapy. The efficiency of screening could be improved by limiting screening to diabetic patients not receiving ACE inhibitor/ARB therapy and without known DKD.

Original languageEnglish (US)
Pages (from-to)1733-1738
Number of pages6
JournalDiabetes Care
Volume29
Issue number8
DOIs
StatePublished - 2006
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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